HomeMy WebLinkAboutH2023-0796 - Permits�EWvoT City of Newport Beach III II I II I III II II IIIIII II
"p�,; S Community Development Department- Building Division Mechanical Permit
t iq'. 100 Civic Center Drive, Newport Beach, CA 92660 Plan Check No
' _ = Permit Counter Phone: (949) 718-1888 " Work Class : Other
.a� newportbeachca.gov/civic
c r Issued Date: 12/21/2023
9L OR
Inspection Area : 4
H2O23-0796
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION, BUT NO LATER THAN 3 YEARS FROM ORIGINAL ISSUANCE DATE
NO CONSTRUCTION RELATED NOISE ON SATURDAY OR SUNDAY IN HIGH DENSITY AREAS AND NO WORK ON SUNDAY AND HOLIDAYS IN ALL AREAS
Job Address : B01 CAMPHOR ST Legal Desc : N TR 4892 BLK LOT 39
Description: MECH INSTALL HVAC SYSTEM **TAMPER RESISTANT CAPS REQUIRED &TIMERS PROHIBITED**
Owner: MICHAEL HODGES Contractor GOETTL AIR CONDITIONING & PLUMBING
Address: 801 CAMPHOR ST NEWPORT BEACH, CA 92660 Address : 532 MALLOY COURT CORONA, CA 92880
Phone: Phone : (714) 462-8174
Con State Lic : 1047781
Applicant: GOETTL AIR CONDITIONING & PLUMBING
Address: 532 MALLOY COURT CORONA, CA 92880
Phone: (714) 462-8174
Owner/Builder :
Address
Phone:
Code Edition : 2022 Fire Hazard Zone : NO
Type of Construction
Occupancy Groups:
Building Setbacks : Front: 10, Side: 6, Side: 6, Rear: 6
Flood Zone: X
Use Zone : R-1-6000 - Single -Unit Residential (6000 indicates -minimum lot area)
PROCESSED BY:
SPECIAL CONDITIONS:
Lic Expire : 12/31/2024
Bus Lic: BT30077958
Bus Lic Expire:02128/2024
Workers' Compensation Insurance
Carrier : AMERISURE MUTUAL INSURANCE COMPANY
Policy No: 21221200002
W. C. Expire : 12/1/2024
Manufacturer: AMERICAN STANDARD
Model# : 4A6H4042
TIMERS PRC � , _ � .
ON HEAT PUPAP�:
DECLARATION
I hereby affirm under penaltyof perjury that t. am exam pt.from . the Contractors` State License Law for the reason(s) indicated below by the checkmark(s) I have placed next to the applicable item(s)
Section 7031.5. Business and Professions Code: Any city or county that requires a permiLto Ddnstr af, after, improve, demolish, or repair any structure,priorto its issuance, 81SO requires the applicant for
he permit to file a signed statement thathe or she is licensed pursuantto the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
)rofessions Code) or that he or she is exempt from licensure and the basis for the alleged exempt:cn. Any violation of Section 703 .6 by any applicant fora. permit subjects [he applicant to a civil penalty of
lot more than five hundred dollars ($500).
I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or (_) portions of the work, and the structure is not intended oroffered for sale (Section 7044,
iusinessand Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the
mprovements are not intended or offered for sale, if, however, the building. or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or
�m roved for the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed Contractors to constructthe project (Section 7044, Business and Professions Code: The Contractors' State License' Law does not
`ppty to an owner of property who builds or Improves thereon and who contracts for the projects with a licensed Contractor pursuantto the Contractors' State License Law),
l am exempt from licensure under the Contractors' State License Law for file following reasom _ ___ ___ ____ ____ „____ __ __,._._,,,______, _ .
ly my signature below I'. acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of tho improvements covered by this permit, I cannot legalli
sell a structure that I have built asan owner -builder If it has not been'. constructed in its. entirety by licensed Contractors. I understand that copy of the applicable law, Section. 7044 of the Business and
'rofessions Code, isavailable upon request when this application is submitted or of the following Web site:http:/lwww.leginfo.ca,govfcalaw.html.
Signature of Property Owner or Authorized Agent _ pate
JCENSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000 ) D' )slag 3-of the Business and Professions' Q nse'{t,'� is o fuilforce
and effect. License Class License No Date `r,�/t��� Contractor Signature
t/ORKERS' COMPENSATION DECLARATION
MRNING: FAILURE TO SECURE WORHERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE'HUNDRED THOVSANWBO LARK ($100,000l, IN ADDITION TO THE
POST OF COMPENSATni DAMAOES AS PROVIDED FOR IN SECTION SZOe OF THE LABOR CODE, INTEREST, AND ATTORNEV'S FEES.
hereby affirm under penaltyof perjury one of the following declarations:
-1 1 have and will maintain a certificate of consent to self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for IN
20giriance of the work for which this permltis fssuod. Policy No.
and will maintain workers' compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers`
carrier and policy number are:
Policy. Number
of Agent
Date
certify that, in the performance of the work for which this permit Is issued, f shall not enI any person in any manner so as to become subject to the workers' compensation laws of California, and
, If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code,. I shall forthwith comply with those provisions.
Iil,00aireof Applicant-.-_.. ______.._ ..___.__,.__.__.. _ _. _..____ .._.._______. _.__—.___..__. _.- — Dati
IF.CLARATION RECARDiNd-CONSTRUCTION LENDING AGENCY
hereby affirm under penalty Of perjury that there, Is a construction lending agency for the performance of the work for which' thispermIt is issued. (Section 3097, Civil Cooe)..
Enders Name Lenders Address
ly rnv signature talon. I _,anify to each of the following:
I a,n the property owner orautbcrized to act on the property owner's'. behalf.
i ;Iwe read tP it ul r- 1Jat on and the Information 1 have provided is correct.
i aq.;ae to comply with all applicable city and county old' Gas and state laws retail .(ding construction
I a-i:hodze representatives of this city or wunty to enter eve-identl perry for Inspection purposes. �1F
Ii nature of Property Owner or Authorized Anent / � Print Property Owner's or Authorized Aaent's Name
A,_,IJ,J
DATE
BY _ JDESPRATION OF COMPLIANCE WITH CODE OF FEDERAL
FOR OFFICE USE ONLY 1
6ULATIONS PART E t OF TITLE 40 AND AOMD RU LF
1403
PERMI r EXPIRED
f SUBM1TTF0i NOTIFICATION TO
PERMIT CANCELLED
i CPA
PER11AIT EXTENDED
❑AOM6
PERMITFINAL
CERTIFICATE Or
'/��
ASBE5105 NOTIFICATION IS NOT APPLICABLE 10
PROPOSED DEMOLITION
OCCUPANCYISSUED